Yin Xiaoming,Zhao Qian,Liu Xin,et al.Comparison of prognosis of patients with unilateral SFU Ⅳ degree ureteropelvic junction obstruction of differential preoperative split renal function:a multicenter retrospective cohort study[J].Journal of Clinical Pediatric Surgery,,19():203-208.[doi:10.3969/j.issn.1671-6353.2020.03.003]
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Comparison of prognosis of patients with unilateral SFU Ⅳ degree ureteropelvic junction obstruction of differential preoperative split renal function:a multicenter retrospective cohort study

Journal of Clinical Pediatric Surgery[ISSN:1671-6353/CN:43-1380/R] volume: 第19卷 Number: 2020 03 Page: 203-208 Column: 专题·肾积水 Date of publication: 2020-03-30
Author(s):
Yin Xiaoming1;  Zhao Qian1;  Liu Xin1;  Yang Yi1;  Wang Xiang2;  Zhang Bin2;  Chen Fang3;  Xie Hua3;  Chen Yan3;  Song Hongcheng4;  Han Wenwen4
1. Department of Pediatric Urology, Affiliated Shengjing Hospital, China Medical University, Shenyang 110004, China;
2. Department of Pediatric Urology, Children’s Hospital of Fudan University, Shanghai 201102, China;
3. Department of Pediatric Urology, Children’s Hospital of Shanghai, Shanghai 200040, China;
4. Department of Pediatric Urology, Affiliated Beijing Children’s Hospital, Capital Medical University, Beijing 100045, China
Keywords:
Pyeloplasty; Ureteropelvic Junction Obstruction; Surgical Procedures; Operative; Treatment Outcome
CLC:
R726.9;R692.7
DOI:
10.3969/j.issn.1671-6353.2020.03.003
Abstract:
Objective To compare the prognoses of children with unilateral SFU Ⅳ degree ureteropelvic junction obstruction (UPJO) of differential preoperative split renal function (SRF).Methods For this multicenter cohort study,retrospective reviews were conducted for 281 cases with unilateral SFU Ⅳ UPJO undergoing Anderson-Hynes pyeloplasty at four domestic institutions from January 1,2016 to December 31,2018.After propensity score-matching,214 patients were divided into groups with preoperative renal function ≥40% and <40%.The clinical data of demographics,preoperative examinations,operative approaches,renal morphology recovery at 6 months post-operation,renal function recovery at 6 months post-operation and postoperative complications were analyzed statistically.Results As compared with SRF<40% group,the median SRF at 6 months of SRF ≥40% group was higher (48.8% vs. 42.1%,P<0.001) and the proportion of children with normal postoperative renal function was higher (75.7% vs.35.5%,P<0.001).However,the SRF recovery was lower (1.6% vs. 9.0%,P<0.001).Conclusion Although children with preoperative SRF≥40% had less renal function recovery at 6 months post-operation,the proportion of those with normal postoperative renal function and postoperative SRF at 6 months post-operation were higher.Therefore children with unilateral SFU Ⅳ UPJO should be operated when SRF≥40% of them have clinical symptoms and hydronephrosis is aggravated,rather than after renal function drops below 40%.

References:

1 Han SW,Lee SE,Kim JH,et al.Does delayed operation for pediatric ureteropelvic junction obstruction cause histopathological changes?[J].J Urol,1998,160:984-988.DOI:10.1097/00005392-199809020-00004.
2 中华医学会小儿外科分会泌尿外科学组.先天性肾盂输尿管交界处梗阻诊疗专家共识[J].中华小儿外科杂志,2018,39(11):804-810.DOI:10.3760/cma.j.issn.0253-3006.2018.11.002. Group of Urological Surgery, Branch of Pediatric Surgery, Chinese Medical Association[J].Chin J Pediatr Surg,2018,39(11):804-810.DOI:10.3760/cma.j.issn.0253-3006.2018.11.002.
3 Ulman I,Jayanthi VR,Koff SA.The long-term follow-up of newborns with severe unilateral hydronephrosis initially treated nonoperatively[J].J Urol,2000,164:1101-1105.DOI:10.1097/00005392-200009020-00046.
4 Kim SO,Yu HS,Hwang IS,et al.Early pyeloplasty for recovery of parenchymal thickness in children with unilateral ureteropelvic junction obstruction[J].Urol Int,2014,92(4):473-476.DOI:10.1159/000357144.
5 Sinha A,Bagga A,Krishna A,et al.Revised guidelines on management of antenatal hydronephrosis[J].Indian Pediatr,2013,50(2):215-231.DOI:10.1007/s13312-013-0064-6.
6 殷晓鸣,杨屹.欧洲泌尿外科学会2017年版肾盂输尿管交界处梗阻诊疗指南解读[J].临床小儿外科杂志,2018,17(7):486-488.DOI:10.3969/j.issn.1671-6353.2018.07.002. Yin XM,Yang Y.Interpretations of 2017 European Association of Urology’s Guidelines of Diagnosing & Treating Ureteropelvic Junction Obstruction[J].J Clin Ped Sur,2018,17(7):486-488.DOI:10.3969/j.issn.1671-6353.2018.07.002.
7 Prigent A,Cosgrif P,Gates GF,et al.Consensus report on quality control of quantitative measurements of renal function obtained from renogram:International Consensus Committee from the Scientific Committee of Radionuclides in Nephrourology[J].Semin Nucl Med,1999,29(2):146-159.DOI:10.1016/s0001-2998(99)80005-1.
8 Eskild-Jensen A,Gordon I,Piepsz A,et al.Interpretation of the renogram:problems and pitfalls in hydronephrosis in children[J].BJU Int,2004,94(6):887-892.DOI:10.1111/j.1464-410X.2004.05052.x.
9 Eskild-Jensen A,Munch J?rgensen T,Olsen LH,et al.Renal function may not be restored when using decreasing differential function as the criterion for surgery in unilateral hydronephrosis[J].BJU Int,2003,92(7):779-782.DOI:10.1046/j.1464-410x.2003.04476.x
10 Salem YH,Majd M,Rushton HG,et al.Outcome analysis of pediatric pyeloplasty as a function of patient age,presentation and differential renal function[J].J Urol,1995,154(5):1889-1893.
11 Harraz AM,Helmy T,Taha DE,et al.Changes in differential renal function after pyeloplasty in children[J].J Urol,2013,190(4):1468-1473.DOI:10.1016/j.juro.2013.01.004.
12 Nishi M,Matsumoto K,Fujita T,et al.Improvement in renal function and symptoms of patients treated with laparoscopic pyeloplasty for ureteropelvic junction obstruction with less than 20% split renal function[J].J Endourol,2016,30(11):1214-1218.DOI:10.1089/end.2016.0553.
13 Kumar K,Ahmad A,Kumar S,et al.Evaluation of renal histopathological changes,as a predictor of recoverability of renal function following pyeloplasty for ureteropelvic junction obstruction[J].Nephro Urol Mon,2015,7(4):e28051.DOI:10.5812/numonthly.28051.
14 Walker MR,Babikian S,Ernest AJ,et al.Sonographic evaluation of hydronephrosis in the pediatric population:is well-tempered sonography necessary?[J].J Ultrasound Med,2015,34(4):655-662.DOI:10.7863/ultra.34.4.655.
15 Helmy TE,Harraz A,Sharaf DE,et al.Can renal ultrasonography predict early success after pyeloplasty in children? A prospective study[J].Urol Int,2014,93(4):406-410.DOI:10.1159/000362504.
16 Seixas-Mikelus SA,Jenkins LC,Williot P,et al.Pediatric pyeloplasty:comparison of literature meta-analysis of laparoscopic and open techniques with open surgery at a single institution[J].J Urol,2009,182:2428-2432.DOI:10.1016/j.juro.2009.07.051.
17 Romao RLP,Koyle MA,Pippi Salle JL,et al.Failed pyeloplasty in children:revisiting the unknown[J].Urology,2013,82(5):1145-1149.DOI:10.1016/j.urology.2013.06.049.
18 Cost NG,Prieto JC,Wilcox DT.Screening ultrasound in follow-up after pediatric pyeloplasty[J].Urology,2010,76(1):175-179.DOI:10.1016/j.urology.2009.09.092.
19 Rickard M,Braga LH,Oliveria JP,et al.Percent improvement in renal pelvis antero-posterior diameter (PIAPD):Prospective validation and further exploration of cut-off values that predict success after pyeloplasty in children supporting safe monitoring with ultrasound alone[J].J Pediatr Urol,2016,12(4):228.e1-e6.DOI:10.1016/j.jpurol.2016.04.003.

Memo

收稿日期:2020-01-05。
基金项目:国家自然科学基金（编号：81571514）
通讯作者:杨屹,Email:yangy2@sj-hospital.org

Last Update: 1900-01-01